Long-term relation between breastfeeding and development of atopy and asthma in children and young adults: a longitudinal study

doi:10.1016/S0140-6736(02)11025-7

The Lancet

Volume 360, Issue 9337, 21 September 2002, Pages 901-907

https://doi.org/10.1016/S0140-6736(02)11025-7 Get rights and content

Summary

Background

Breastfeeding is widely advocated to reduce risk of atopy and asthma, but the evidence for such an effect is conflicting. We aimed to assess long-term outcomes of asthma and atopy related to breastfeeding in a New Zealand birth cohort.

Methods

Our cohort consisted of 1037 of 1139 children born in Dunedin, New Zealand, between April, 1972, and March, 1973, and residing in Otago province at age 3 years. Children were assessed every 2–5 years from ages 9 to 26 years with respiratory questionnaires, pulmonary function, bronchial challenge, and allergy skin tests. History of breastfeeding had been independently recorded in early childhood.

Findings

504 (49%) of 1037 eligible children were breastfed (4 weeks or longer) and 533 (51%) were not. More children who were breastfed were atopic at all ages from 13 to 21 years to cats (p=0·0001), house dust mites (p=0·0010), and grass pollen (p<0·0001) than those who were not. More children who were breastfed reported current asthma at each assessment between age 9 (p=0·0008) and 26 years (p=0·0008) than those who were not. Breastfeeding effects were not affected by parental history of hayfever or asthma. Multifactor analysis controlling for socioeconomic status, parental smoking, birth order, and use of sheepskin bedding in infancy, showed odds ratios of 1·94 (95% CI 1·42–2·65, p<0·0001) for any allergen positive at age 13 years, 2·40 (1·36–4·26, p=0·0003) for current asthma at 9 years, and 1·83 (1·35–2·47, p<0·0001) for current asthma at 9–26 years by repeated-measures analysis.

Interpretation

Breastfeeding does not protect children against atopy and asthma and may even increase the risk.

Introduction

Most reviews of risk factors for asthma recommend extended breastfeeding to reduce the probability of development of atopy and asthma in childhood. Although such a view is widely accepted and promoted, few investigators have adequately addressed the issue, and their results are conflicting.

In 1988, Kramer¹ Proposed 12 criteria for studies in which the relation between breastfeeding and development of atopy and asthma are assessed (panel). He suggested that previous studies contained flaws in design or implementation, including selection of the study population, retrospective recall bias about feeding history, short duration of follow-up, inadequate definition of outcomes, and failure to consider confounding variables. Despite further studies, controversy persists. Some investigators have reported protection,2, 3, 4, 5, 6, 7 whereas others suggest an increased risk of allergy and asthma associated with breastfeeding.8, 9, 10, 11, 12

We have examined outcomes of asthma and atopy related to breastfeeding in a population-based birthcohort study of New Zealand children which fulfills the criteria shown in the panel. Our hypothesis was that breastfeeding would protect against development of atopy and asthma in childhood.

Section snippets

Participants

All 1661 live-born children delivered at Queen Mary Hospital, Dunedin, New Zealand, between April, 1972, and March, 1973, were included in a neonatal study.¹³ Children from this cohort who were resident in the province of Otago at age 3 years were invited to participate in the longitudinal Dunedin Multidisciplinary Health and Development Research Study. We enrolled 1037 (91%) of 1139 eligible children. Cohort families represented the full range of socioeconomic status in the general population

Results

Of 1037 children in the longitudinal study, 463 (45%) were not breastfed. In 70 (7%) children, breastfeeding was attempted but was discontinued before the child was 4 weeks old. Preliminary analyses showed that these 70 children had outcomes much the same as those who were not breastfed, and quite different to those breastfed for 4 weeks or longer. These 70 children were therefore included in the non-breastfed group, making a total of 533 children (51%). Mean duration of breastfeeding in the

Discussion

Our results provide substantial evidence against our initial hypothesis that breastfeeding is protective against atopy and asthma. By contrast, breastfeeding for 4 weeks or longer increased the likelihood of skin test responses to common allergens at age 13 years, and more than doubled the risk of diagnosed asthma in mid-childhood, with effects persisting into adulthood.

We investigated a large unselected population-based birth cohort, in which roughly equal numbers were breastfed and not

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Citation Excerpt :
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Postnatal exposures, including breastfeeding, may influence asthma development.
To investigate the association between breastfeeding duration and child asthma.
We studied 2021 mother-child dyads in the ECHO PATHWAYS consortium of prospective pregnancy cohorts (GAPPS, CANDLE, TIDES). Women reported the duration of any and exclusive breastfeeding and child asthma outcomes during follow-up at child age 4 to 6 years. Outcomes included current wheeze (previous 12 months), ever asthma, current asthma (having ≥2 of current wheeze, ever asthma, medication use in past 12-24 months), and strict current asthma (ever asthma with either or both current wheeze and medication use in past 12-24 months). We used multivariable logistic regression to assess associations (odds ratios and 95% confidence intervals) between breastfeeding and asthma outcomes adjusting for potential confounders. We assessed effect modification by mode of delivery, infant sex, and maternal asthma.
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Longer duration of exclusive breastfeeding had a protective association with child asthma.

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ArticlesLong-term relation between breastfeeding and development of atopy and asthma in children and young adults: a longitudinal study

Summary

Background

Methods

Findings

Interpretation

Introduction

Section snippets

Participants

Results

Discussion

J Pediatr

J Allergy Clin Immunol

Br J Dis Chest

J Allergy Clin Immunol

Immunol Today

J Pediatr

Pediatr Clin N Am

Allergic diseases in Swedish school children

Acta Paediatr Scand

The development of allergy in infants of allergic parents: a prospective study concerning the role of heredity

Ann Allergy

Five-year follow-up of high risk infants with family history of allergy who were exclusively breast-fed or fed partial whey hydrolysate, soy, and conventional cow's milk formulas

J Pediatr Gastroenterol Nutr

Association between breast feeding and asthma in 6 year old children: findings of a prospective birth cohort study

BMJ

Effects of passive smoking and breastfeeding on childhood bronchial asthma

East Afr Med J

Breastfeeding and asthma among Brazilian children

J Asthma

Biosocial factors in the epidemiology of childhood asthma in a British national sample

J Epidemiol Commun Health

Breast feeding, eczema, asthma, and hayfever

J Epidemiol Commun Health

Factors influencing the relation of infant feeding to asthma and recurrent wheeze in childhood

Thorax

for the SIDRIA collaborative group. Risk factors for early, persistent, and late-onset wheezing in young children

Am J Respir Crit Care Med

Perinatal events in the Dunedin city population 1967–73

NZ Med J

Articles
Long-term relation between breastfeeding and development of atopy and asthma in children and young adults: a longitudinal study